The Second Victim Effect in Medicine: Not Just for Interns

By Marjorie Stiegler on January 27, 2015 in Error Disclosure, Medical Mistake, Perioperative Catastrophe, Second Victim, Simulation
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“I may have experienced PTSD,  causing memories of that event to be very deeply etched.  I can, after 25 years, describe her in fine detail, down to the dress she was wearing and her hair-do.  No other patient remains so clear to me.” 

Yesterday, the January issue of JAMA was published.  I authored a piece entitled  What I Learned About Adverse Events From Captain Sully: It’s Not What You Think.  Of course, this publication is a proud moment for me, since JAMA is the most widely circulated medical journal in the world.  I have been very excited ever since it was accepted, and looking forward to the professional satisfaction of seeing it in print.

Today, I was fully immersed in an intense simulation –  22 anesthesiology residents completing four simulated emergency situations.  When I emerged and the end of the day, my email was overflowing with messages from people who had read the piece, and whom I will likely never have the pleasure to meet.   These messages shared stories from peoples’ darkest moments – extremely personal anecdotes – and are reflected in the short excerpts included in this post in italics.  Thank you, fellow physicians, for sharing your deeply private experiences with a complete stranger like me.   I have enormous gratitude for the honor of receiving them, and it is my hope that this article helps to move our profession and our humanism forward.

JAMA article January 2015

When I was an intern in 1969, a relatively young hospitalized woman (30s) died suddenly.The attending was so distraught that after meeting with the family, he turned to me and said that he had to leave and asked me to cover the service for the rest of the afternoon. I was aghast and thought that he was abandoning the other patients. Now 45 years later, I understand why he did what he did.”

“In 1983, when  I was training as a cardiologist, on the first occasion that I used an Amplatz catheter (different from the usual Judkin’s catheter), as I cannulated the left main coronary , the vessel dissected (I dissected the vessel?), and after hours of aggressive resuscitation attempts, the patient died.  I was never blamed. But I was devastated. Nonetheless, I was expected to be (and was) back in the cath lab the next morning. Over the years, I’ve never forgotten that patient or the events of that day. Now, 32 years later, after a successful career as an invasive cardiologist and nearing retirement, it still haunts me.”
“Ten years ago I spent six months in Sudan with MSF. A lot of “bad stuff” happened to patients, though I never felt personally in danger. I have never really gotten over it. I kept a journal of that time. After ten years I still can’t open that journal.  I’ve never told anyone this.”
“I’m a retired emergency room physician and was one of the first to go through the certification process. I practiced in the busiest emergency room in Montana back in the 70’s and 80’s and I worked alone. The busier I was the more I liked it. But now I know that it took a toll on me. I just remember that there was a lot of heartache at times.  I remember with all the sadness and crises that was going on around me, I just didn’t have time to grieve with the patient’s or their relatives or really think about what had just happened. There was always a patient waiting to be seen. [For the next ten years after my medical career ended] I had dreams about being in the ER. I have very vivid dreams and in the ER dreams there was always some crises and I didn’t want to be there!  My wife is convinced that my dreams are indicating PTSD.  She maybe right. You raise some very interesting questions in your excellent article. Thank you so much for taking the time and thought to write it and I will make sure that my physician son, Jason, gets a copy of it.”

You can read the entire article on JAMA’s website by clicking on the article image above.

If this resonates with you, please share it with someone you care about.

4 Comments

  1. James Smith February 3, 2015 Reply

    Its a great article and it resonates with my experience. After 30 years of general surgery, trauma, open abdomens, deaths and the subsequent legal experiences I wound up hospitalized in a “Stress unit” two years ago. I am starting to get my life back two years later. I cut back my practice, went on medication, and joined Heartwork meditation group. I liked the article, but it stops short of a call to action. The Harvard system appears to be the only one I could find that has a program for health care profesionals to decompress after an adverse effect. We need to set up a national policy or suggestions for all hospitals to offer to the healthcare professionals who experience an adverse event.

  2. John February 7, 2015 Reply

    Congrats on this article and so concisely bringing up a problem that organized medicine has largely ignored and many of us in the trenches have so long denied. I sat with a VA counselor a few months ago to discuss future benefits and to stay plugged into the system. This Vietnam veteran and former Army First Sergeant looked at me and said “Doc, you have PTSD!” I told him that I was fine and the only problem I had was my nagging back and leg pain. He started asking me a few questions about the things I’ve seen over the last 18 years of my practice as an anesthesiologist and Flight Surgeon. It didn’t take long before I was crying behind the closed door of his office and I couldn’t understand where that emotion came from. I am a strong independent anesthesiologists with years of experience and I did recognize the issues that I have been forced to suppress over the years to keep marching on.
    I remember working with a thoracic surgeon early in my career to care for a patient with a hilar tumor that was wrapped around the patients pulmonary vessels. He remarked to me that there was nothing he could do. I assumed he would close and i would simply wake the patient up and take the patient back live out the remainder of his short life with his family. The patient had few co-morbidties and it should be no problem to wake the patient up. The surgeon continued to dig around on his pulmonary arteries and veins with a suction catheter and he tore the vessels. The blood pressure immediately dropped and I took the steps to save the patient and he remarked , “don’t bother, I am not going to repair the tear”. In just a few minutes the patient died and I was distraught and furious. After moving the dead patient out of the room, the surgeon wanted to know how long it would be before we could get the next patient in the room. I remember every detail like it was yesterday.
    Unfortunately this was just one of many of the things that I have experienced or seen in my career. At the urging of family and the VA counselor, I have taken steps to talk with professionals about the issues that may be hiding in the shadows. I appreciate your article because there are many more physicians that might be saved or spared from the feeling of hopelessness and helplessness.The practice of medicine and many of our fellow heartless “physicians” impose these feeling upon us but fortunately “colleagues” like you are helping to bring the problem to the forefront. Thank You.

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